Evidence Molded by Contact with Staff Culture and Patient Milieu: an Analysis of the Social Process of Knowledge Utilization in Nursing Homes

Abstract

Knowledge utilization is politically “hot” because it informs decisions on improving the quality of care in nursing homes (NHs). The difficulties encountered in implementing evidence-based knowledge into practice may be explained by contextual factors. Contextual factors are crucial to understanding the process of knowledge utilization; how the evidence’ is implemented and received locally by identifying facilitators, as well as barriers to change. This article is based on an evidence-based education intervention executed by four teams of two facilitators with care staff, which aimed to prevent the use of restraint in nursing home (NH) residents with dementia in 24 NHs in Norway. The study used a mixed method design combining cluster randomized controlled trial (C-RCT), participatory action research (PAR) and ethnography, where the aim was to document and examine the success or failure of the education intervention. The empirical material for this paper is primarily based on a post –intervention ethnographic investigation in three NHs in the sample, to investigate the relationship between an education intervention and staff culture. The ethnographic investigation gave a setting and context-specific plausible explanation of why the educational intervention failed or succeeded. This study has shown that the social process of knowledge utilization is influenced by contextual factors such as staff culture, patient mix and milieu as well as structural conditions. The NH conditions are not stable, but rather moving and constantly changing as a response to variation in the staff culture, the patient mix, the resources available and the nursing homes current situation. Therefore, the evidence in connection with staff culture could be understood as “a ball of clay” molding itself differently when coming in touch with staff culture and their collective and individual experiences. Potential for a successful process of knowledge utilization has to do with timing and organizational readiness, which is difficult to foresee when planning an education intervention.

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